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Critical care
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AceOfHearts<3 specializes in Critical care.

"It's your choice, Ace. People can live a hundred years without really living for a minute."

AceOfHearts<3's Latest Activity

  1. AceOfHearts<3

    How to effectively delegate in nursing on a unit

    I always liked to demonstrate to the aides that I wasn’t just pushing stuff off on them. ”Hi Ann Aide, Mrs. Smith in room 1 needs to use the bathroom. Can you please assist her while I give Mr. Brown his medication before he goes to physical therapy off the floor. Also, I’m sure Mrs. White in room 3 has been incontinent again and is due to be repositioned- I know she’s a heavy 2 assist so let’s tackle that together and I can assess her skin at the same time”
  2. AceOfHearts<3

    pH in NGTs

    We use X-ray to confirm placement and we always chart how far it is advanced-such as right nare at 60. We then assess aspirate characteristics and that the tube is in the proper spot by the measurements. If the NG tube is for gastric decompression and it’s an emergency then we’ll go off aspirate characteristics. I’ve placed an NG tube for decompression and before I could even hook it up to suction it has had gastric contents backing up into it. Cases like that the risk of the patient vomiting and aspirating is so high that we’ll hook it up to suctioned without X-ray confirmation.
  3. The quote button is not working. The reply below is in response to: “Based my recent experience, no, I don't think anyone is safe. Am only carrying drivers liscence car insurance and maybe 15$ to work now. Also had to put my sweet old collie dog down literally a week ago after this happened. Am I deranged for wondering what's happening to this world? Is nothing sacred? Why try to have anything if it can be taken so thoughtlessly?.” Don’t forget your medical insurance card too. I’ve been seriously hurt on the drive to work before. I don’t leave the house without it.
  4. AceOfHearts<3

    Crying at work

    I’m an ICU nurse. I’ve had a patient that I knew something more was going on with and I made that known. I watched him like a hawk and just had a feeling something horrible was going to happen. A couple of days later when I wasn’t at work it happened-the patient crashed and crashed bad. When I found out the next shift I worked, I had an ugly cry in the car on my way home from work. Sometimes there is more we can do and other times we just have to wait for the milk to spill and clean up the mess.
  5. AceOfHearts<3

    Need some advice. Asked to do pedi nursing.

    I would say you don’t have experience with pediatric patients. I would also add that they are not just smaller versions of adults- they are their own specialty- and they should have/want a nurse with experience in peds. ”I’m sorry, I just don’t have the experience with the pediatric population that you should want and expect. Thank you for the offer though, it is very flattering.”
  6. AceOfHearts<3

    Obtaining Supplies School Project

    Most of the time we have what we need. It’s very frustrating when we run out of basic supplies and it appears the supply person isn’t doing their job properly. It’s irritating to have to search for a new pulse ox or call a million times when we need more masks or gowns for an isolation room. Sometimes the linen cart doesn’t get refreshed and we run out of gowns and wash clothes. It’s pretty hard to give meds through an NG tube without a syringe or clean a patient up if there is no soap. These are things we use on a regular basis everyday and we should never run so low that we run out- we normally have plenty to spare because they are basic items in the ICU.
  7. AceOfHearts<3

    BLS renewal—ouch

    I avoid doing compressions if at all possible because it exacerbates an old injury. I can do them and certainly jump in and do my share when needed, but I tend to pick other roles otherwise I tend to be in severe pain for several days. Daisy- I feel like the in-person renewal portion for BLS is way worse than ACLS.
  8. AceOfHearts<3

    Written Up

    Don’t worry, The Joint Commission is now cracking down on this. Any duplicate therapy PRN medications must clearly state what to give and when. This applies for anxiety, pain, bowel regimen meds, etc. and without very clear cut directions, per TJC, it is out of the scope of our practice to decide what to give the patient. So the order will need to say give Med A first and 2 hours later if no relief give Med B. Or something similar to that depending on the meds and indication.
  9. AceOfHearts<3

    Losing job due to injury

    Short term disability made a difference to me too. My workplace automatically deducts it- I don’t even think we have the option to waive it. OP- I understand how you are feeling. I was in an accident through no fault of my own and was out of work for an extended period of time. I hadn’t been at my job for a year yet, so I too didn’t qualify for FMLA. It was hard being off work and a roller coaster of a ride. The day I confirmed I wouldn’t be able to return to work for an unknown number of weeks more I had a very ugly cry session in my car. Best of luck and if you ever need someone to listen, feel free to send me a PM. I don’t want to give too many details on here.
  10. AceOfHearts<3

    How to be on an ICU Nurse's good side?

    One of my huge pet peeves is when I’m asked about hourly output- whether it’s a drain, urine, etc. or some other vital like temperatures (wanting to know if the patient was febrile and how high it went). All of that is charted and there is a reason we do hourly intake and output- take the 30 seconds to look it up. I sometimes wonder why I even bother charting things when it’s clear certain providers never even bother to look at it (and I know I’m charting it for other reasons too, but it’s just super frustrating). For the most part I don’t mind answering questions, but if I’m clearly busy (especially if I’m doing something with my other patient) or it’s something that should very obviously be charted it gets a little old (especially when I have multiple people from different disciplines asking the same questions in a short time frame).
  11. AceOfHearts<3

    feeling bad after a rapid response on your patient

    Calm down- you aren’t the only one to feel like this and you certainly won’t be the last. Did your team debrief after this all happened? If not, ask to do so in the future. Do you have EAP available to you? I think most workplaces in the USA offer it and this is exactly what it is there for. You can also reach out to your manager and/or clinical educator if you want to talk about the situation clinically. A chaplain is also a good person to speak with if you just need to voice your feelings. It’s reasonable to initially think about what happened and wonder “what if...?”, but you also have to be able to move past it. Take it as a learning experience and know you’ll be better prepared the next time it happens. You got this! Good luck!
  12. You came here asking for advice and didn’t like what Ruby had to say. Ruby gave you some tough love- you’re in your third job in less than two years!!! You can’t afford to quit again. You’re an adult now and have adult responsibilities, so yes you do need to suck it up for a bit. And trust me, I know what it is like to have a job you absolutely hate. I sucked it up for 1.5 years and I’m better for it. I’m friendly to the new hires in my ICU. I don’t say I’m friends with them yet as that takes time. I’ve been at my current job for 2 years and I’m not friends with that many of my coworkers outside of work. As another coworker says- I’m there to work and not make friends. I have plenty of friends outside of the job. If you need help making friends join a meet-up group- that is literally what they are for (making friends). Have you reached out to the clinical educator at your job? They might have some resources that will help you.
  13. AceOfHearts<3

    help me prioritize please

    You need to get comfortable delegating or you aren’t going to make it. You can be nice, but you need to be clear and firm. When I worked the floor I found it helpful to almost explain my delegation- “Please help Mrs. White in room 3 to the bathroom while I check Mr. Brown’s blood pressure and give him pain meds.” Yes, all of the things the aides do fall under your job title too, but there are many things YOU do that they can’t. Their job is to do what they can to keep the nurse free for tasks only the nurse can complete. That’s not to say that you never get a blood sugar or help with ADLs, but your priority is on assessing the patients, chart and lab reviews, meds, discussing plan of care with the patient and doctors, etc. It sounds to me that the aides are taking advantage of you being new. You aren’t the first new nurse they’ll have seen.
  14. AceOfHearts<3


    I agree with this 100%- it wasn’t just you that missed it. Your other mistakes are minor and should just require a review of policies.
  15. AceOfHearts<3

    What is your procedure for passing ice water?

    I’m in the ICU and if my patient is able and allowed to eat/drink I tend to always bring a fresh cup in with me for morning meds. I never know how long the other stuff has been sitting in the room unless it’s still cold and filled with ice and I certainly don’t like drinking old stale tasting water, so I don’t expect my patients to drink it either. When I worked on the floor our aides took care of it at scheduled times of the day (and obviously as needed). We marked on the water pitcher exactly how much a patient could have at what time if they were fluid restricted.
  16. AceOfHearts<3

    Nurse Charged With Homicide

    I always check the name and dosage on any med. I work in an ICU in the USA and I once pulled an IV antibiotic out of the med room that was labeled for my patient, the correct time was on it, the correct med name was on it etc. but it was NOT the correct med. Pharmacy had put the label on an entirely different antibiotic. I wasn’t impressed with their laissez faire attitude about it. I reported it to my manger with the evidence (the clearly mislabeled med) and filed an event report about it. I check my meds at a computer outside of the patient’s room first, then I take them in and look over them again while scanning (I also say what the med is and why they are getting it- here is your 5mg amlodipine, brand name Norvasc, for your high blood pressure, etc), and another time when I open them. If it’s an IV infusion I also always check that the med matches the infusion info that is programmed into the pumps. We have some meds that the concentration has changed because of manufacturing issues- what may have been in 100ml now might be only in 50ml. If I select the med and strength and go with the pre-programmed information the patient will get the med in 15 minutes instead of the intended 30 minutes (as ordered). I’ve also had it where the next shift left me a new bag on the WOW for a continuous gtt that was running low. I once correctly scanned a med and verified it was correct, but then picked up the wrong one from the WOW. I’m so meticulous with checking the bag, the pump, and my MAR that I caught my mistake. If I had hung the other med and programmed it as the one that I had scanned out the patient in all likelihood would have died. Never leave spare meds on your workstation- it’s a disaster waiting to happen.